Healthcare Provider Details

I. General information

NPI: 1679881999
Provider Name (Legal Business Name): MATTHEW JEREMY DAWSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MACARTHUR DR
ALEXANDRIA LA
71303-3111
US

IV. Provider business mailing address

604 MACARTHUR DR
ALEXANDRIA LA
71303-3111
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-5710
  • Fax: 318-442-4487
Mailing address:
  • Phone: 318-442-5710
  • Fax: 318-442-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17602
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: